There is limited data on eating habits of pediatric patients with eosinophilic esophagitis (EoE). We sought to change that with a prospective, observational study that included patients with EoE and healthy control subjects. We videotaped patients eating four different textures – puree, soft solid, chewable and hard solid – to determine any changes in eating behaviors that may occur in the setting of an inflamed esophagus.
Our study included 27 patients with EoE, and 25 healthy control subjects – all pediatric patients with a mean age of 11, and an approximate 6:4 ratio of males to females. We tracked the number of chews per bite, sips of fluid per food, and overall consumption time.
For the cohort patients with EoE, we collected data on endoscopic, histologic and esophageal distensibility. Distensibility was determined using the endoFLIP (endoluminal functional lumen imaging probe) to measure the pressure and diameter of the esophagus during endoscopies. We sought to discover the degree of correlation with symptomatology, endoscopic and histologic findings, and esophageal distensibility (and fibrosis) as it related to ongoing feeding issues.
We found patients with EoE demonstrated:
- More chews per bite with three of the four textures compared to patients without EoE:
- Soft solids (13.6 vs. 9.1)
- Chewables (14.7 vs. 10.7)
- Hard solids (19 vs. 12.8)
- Increased consumption time with three of the four textures:
- Soft solids (94.7 vs. 58.3 seconds)
- Chewables (90 vs. 65.1 seconds)
- Hard solids (114.1 vs. 76.4 seconds)
Further subgroup analysis of children with active EoE and inactive EoE showed no significant differences in eating behavior. However, we found total endoscopy reference score positively correlated with consumption time, and for number of chews for both chewable foods and hard solids. Longer consumption time correlated with increased eosinophil count and decreased esophageal distensibility.
Our results showed that pediatric patients with EoE alter their eating behaviors – specifically by increasing chewing and consumption time. These ongoing feeding issues continue even when the patient has achieved histologic remission. Results measured by endoFLIP showed that youth with ongoing feeding issues had decreased distensibility – a sign that fibrosis and remodeling of the esophagus are driving symptoms of EoE.
Amanda B. Muir, MD, MTR, is a pediatric gastroenterologist in the Division of Gastroenterology, Hepatology and Nutrition at Children’s Hospital of Philadelphia.
Citation:
Kennedy KV, Umeweni CN, Alston M, Dolinsky L, McCormack SM, Taylor LA, Bendavid A, Benitez A, Mitchel E, Karakasheva T, Goh V, Maqbool A, Albenberg L, Brown-Whitehorn T, Cianferoni A, Muir AB. Esophageal Remodeling Correlates With Eating Behaviors in Pediatric Eosinophilic Esophagitis. Am J Gastroenterol. 2024 Jun 1;119(6):1167-1176. doi: 10.14309/ajg.0000000000002661. Epub 2024 Jan 18. PMID: 38235740
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There is limited data on eating habits of pediatric patients with eosinophilic esophagitis (EoE). We sought to change that with a prospective, observational study that included patients with EoE and healthy control subjects. We videotaped patients eating four different textures – puree, soft solid, chewable and hard solid – to determine any changes in eating behaviors that may occur in the setting of an inflamed esophagus.
Our study included 27 patients with EoE, and 25 healthy control subjects – all pediatric patients with a mean age of 11, and an approximate 6:4 ratio of males to females. We tracked the number of chews per bite, sips of fluid per food, and overall consumption time.
For the cohort patients with EoE, we collected data on endoscopic, histologic and esophageal distensibility. Distensibility was determined using the endoFLIP (endoluminal functional lumen imaging probe) to measure the pressure and diameter of the esophagus during endoscopies. We sought to discover the degree of correlation with symptomatology, endoscopic and histologic findings, and esophageal distensibility (and fibrosis) as it related to ongoing feeding issues.
We found patients with EoE demonstrated:
- More chews per bite with three of the four textures compared to patients without EoE:
- Soft solids (13.6 vs. 9.1)
- Chewables (14.7 vs. 10.7)
- Hard solids (19 vs. 12.8)
- Increased consumption time with three of the four textures:
- Soft solids (94.7 vs. 58.3 seconds)
- Chewables (90 vs. 65.1 seconds)
- Hard solids (114.1 vs. 76.4 seconds)
Further subgroup analysis of children with active EoE and inactive EoE showed no significant differences in eating behavior. However, we found total endoscopy reference score positively correlated with consumption time, and for number of chews for both chewable foods and hard solids. Longer consumption time correlated with increased eosinophil count and decreased esophageal distensibility.
Our results showed that pediatric patients with EoE alter their eating behaviors – specifically by increasing chewing and consumption time. These ongoing feeding issues continue even when the patient has achieved histologic remission. Results measured by endoFLIP showed that youth with ongoing feeding issues had decreased distensibility – a sign that fibrosis and remodeling of the esophagus are driving symptoms of EoE.
Amanda B. Muir, MD, MTR, is a pediatric gastroenterologist in the Division of Gastroenterology, Hepatology and Nutrition at Children’s Hospital of Philadelphia.
Citation:
Kennedy KV, Umeweni CN, Alston M, Dolinsky L, McCormack SM, Taylor LA, Bendavid A, Benitez A, Mitchel E, Karakasheva T, Goh V, Maqbool A, Albenberg L, Brown-Whitehorn T, Cianferoni A, Muir AB. Esophageal Remodeling Correlates With Eating Behaviors in Pediatric Eosinophilic Esophagitis. Am J Gastroenterol. 2024 Jun 1;119(6):1167-1176. doi: 10.14309/ajg.0000000000002661. Epub 2024 Jan 18. PMID: 38235740
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